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Identifying the causes of low productivity.

Identifying the causes of low productivity

Barriers to improved productivity include problems affecting the system of measuring workload, working conditions, management style, and employee motivation. By Annamarie Barros, M.A., CLS, CLDir(NCA)

Low productivity can be cured if you know how to diagnose your laboratory operation. A systematic evaluation can disclose problems that keep productivity down, and knowing what's wrong is a big step toward a solution.

You have to monitor three major problem areas to find the reasons for low productivity or inefficiency. The first area includes everything that can go wrong when a productivity measurement system like the one developed by CAP has not been properly implemented. A second problem area involves various laboratory systems -- both the physical design of the lab and administrative policies. The final group of productivity-lowering problems consists of deficiencies in management style and employee motivation.

Problems with measurement. Whether the College of American Pathologists' workload recording method is the definitive way to measure productivity is under debate. I consider it a valuable management tool. If instituted and applied properly, CAP workload recording has the advantage of recognizing sources of inefficiency that are imposed on the laboratory from the outside -- medical staff policies, hospital policies, laboratory location, and so on.

Many productivity surveys, including the CAP's program, give comparative figures. A hospital administrator looks at these and says, "According to the figures, your laboratory doesn't compare well with the laboratory at XYZ Hospital."

Such a conclusion may not in fact be warranted because a good deal of invalid data are submitted on the productivity survey forms. You have to demonstrate why your laboratory operation differs from other lab operations or show that the data you keep are valid.

You must also be able to document your productivity in case administration calls in an expert to evaluate the laboratory's efficiency. (Remember, too, that while it is simple enough to develop measurement standards to calculate productivity, these measurements will remain meaningless if lab employees don't accept them or work toward improvement.)

You must always assign correct unit values to all laboratory procedures. I have visited labs recently that still use the 1984 edition of the CAP workload recording manual. I can't determine whether these labs are productive unless I translate their unit values into those from the latest manual. (For specifics about calculating productivity, see MLO's April 1987 article, "Management Applications of Workload Recording -- Part I.")

You also have to count every appropriate item. Labs can lose workload units because they don't count everything that should be counted. All employee hours should be tailed. If technologists at an institution are considered exempt employees and do not earn extra money for extra work, very often no record of their additional time exists. Every one of their hours should be logged, and the hours must be assigned to the correct sections.

Time spent on support activities should accurately reflect the amount of services used by each laboratory section. When allocating hours for support services -- such as clerical and computer work and autoclaving -- use an appropriate formula to distribute these services among sections: each section's percentage of total test volume, for example.

Physician and doctoral staff members' hours are no longer completely excluded in CAP productivity assessments. If a pathologist or a doctoral scientist performs any functions considered part of a CAP workload unit, then these hours should be counted. For example, if a Ph.D. scientist supervises the chemistry section, part of that supervision is counted into the CAP unit value.

Make sure that all procedures, even controls, standards, and repeats, are systematically recorded. One of the biggest failings is not counting repeats. While computer systems pick up most test runs, repeats generally have to be tallied by hand.

Remember that when duplicate specimens are part of the methodology (as for prothrombin time), they count as only one test. A repeat test for quality control, however, is counted as a second, separate procedure.

Don't use billing as the sole source for workload statistics. While billable items give you a good count of the unknowns, they don't include employee specimens, controls, standards, or repeats. You have to devise an additional system to capture this information.

Always use the most precise information possible. This will require work. It's not enough, for example, to keep a strict count of controls for a couple of months and, when you find that 25 per cent of all tests are controls, apply that factor every month thereafter for workload recording. Estimating is inappropriate because there are too many variables involved. With the computer programs available today, keeping accurate counts is not too difficult. Unfortunately, though, laziness often prevails.

Review and update unit values when your laboratory begins a new fiscal year, even though the new edition of the CAP workload recording manual comes out in January. That way, you will be using an updated system for your entire fiscal year instead of part of the year.

System problems. Problems related to laboratory systems can be either external (having to do with working conditions and physical surroundings) or internal (having to do with policies that affect the employee's ability to do a good job).

Problems with the lab environment. Instrumentation must be adequate for the jobs expected of it, in working order, and simple to operate. There should be no shortages of such basic equipment as microscopes, balances, and centrifuges. Similarly, the inventory of reagents and supplies should cover any unexpected rise in test volume. Frequent emergency orders for supplies indicate inventory is insufficient.

Backup instruments can help maintain quality and quantity of work and turnaround time during both scheduled and unexpected downtime. The easiest way to justify replacing an old instrument is to document the amount of downtime and money spent on repairs or labor; the idea is to show that the laboratory could have paid for a new instrument over a number of months with what the downtime cost. The effect on turnaround time would also be part of the justification.

Determine the cost-effective balance between commercial and lab-prepared reagents and media. Laboratory managers often don't add in all of the necessary factors when they calculate the cost of producing reagents in-house. For example, fringe benefits are part of the labor costs. Then there's the overhead involved in storing the reagent chemicals -- possibly the space could be put to better use if a lab relied instead on a vendor to ship reagent kits every month or whenever the supply runs low.

The physical layout of the laboratory should promote an efficient work flow. Different sections should be close together if management wants to encourage cross-training and rotation.

In many labs, the harried night staff has to run from room to room, performing a crossmatch in one place while handling a Stat CBC down the hall. Under such circumstances, it is difficult to organize the work efficiently and achieve 75 per cent productivity.

Hospital administrators usually will approve remodeling if it will cut costs and result in more efficient use of personnel. I recommend a general laboratory area for all of the primary laboratory functions. Microbiology should be in a corner separated from the rest of the lab by a partition; blood banking can be in another corner to isolate it from the lab's constant traffic flow.

With everyone in a common space, an employee waiting 15 minutes for a test to be completed in chemistry can easily move to the adjacent area and lend a hand on urine testing. It also helps, for example, to have hematology next to coagulation so that staff members in these areas can see whether test results on a patient correlate.

Sufficient bench and storage space and enough sinks are essential. Make sure the laboratory is operating under prime conditions; temperature should be tolerable, and the air should be free of dust, offensive odors, and noise. A working phone intercom system saves time and eliminates yelling for someone to pick up.

Watch out for an abnormal number of interruptions -- sales representatives calling without appointments, unnecessary meetings, and idle conversations. Unessential paperwork is another distraction to avoid.

The reporting and filing system should not generate an excessive number of phone requests for data, nor should employees have to spend much time tracking down reports. Everyone should know how to gain access to the filing system and how to use it.

Similarly, the test request procedure should be simple enough to eliminate unnecessary repeat testing and telephone calls for clarification. Do everything you can to make test ordering easier. For instance, program your computer to respond with all of the specimen ordering information nurses need to know or else make available a Rolodex file cross-indexed with tests listed under every possible name and abbreviation.

The laboratory work schedule should be organized to reflect an appropriate mix of levels of expertise and to provide coverage of every section at all times. Schedules and staffing patterns should be flexible.

Problems with policies. Laboratory position descriptions should clearly define duties and responsibilities with accepted minimum standards of performance. The Joint Commission on Accreditation of Healthcare Organizations now requires every hospital department to use competency-based performance appraisals. In order to make these appraisals, laboratories will have to write job descriptions based on competency.

The orientation program should introduce employees to the performance appraisal system, laboratory policies, safety and disaster programs, and appropriate general institutional policies. It should give employees enough time to meet minimum performance standards in all lab areas.

New employees should be adequately trained to use unfamiliar technical procedures and instruments. They should also be introduced to office and clerical procedures. A very basic example: how to use the telephone-hold system so physicians and nurses aren't cut off.

Written policies and procedures should provide each employee with a clear understanding of the employer's standards and expectations for behavior. In addition, employees should be assigned duties commensurate with their education, training, and experience. A highly educated, qualified staff member should not be assigned duties that someone less qualified can perform. Over-qualified employees become bored, frustrated, and disgruntled.

Laboratory in-service education programs should address the needs of physicians and patients. Attendance at continuing education programs outside the laboratory should be encouraged and supported, too.

Management and motivation flaws. The last group of problems that can decrease productivity involves management style and employee motivation. They represent the greatest barriers to improving productivity, and they are not so easy to detect or correct. In this area, managers must take a hard and honest look at their own competence and how it contributes to the efficient operation of the laboratory. They must weigh a variety of policies and employee relationships in order to correct problems.

A management by objectives system should exist, with employees evaluated on the basis of whether they achieve their objectives. Performance appraisals should be used to assist employees' growth and development, not as the basis for punishment. Nonetheless, employees must be held accountable for performance.

Are first-line supervisors active members of the management team, rather than supervisors in name only or just technical specialists? They should participate in the selection process for new employees and help develop the budget and plans for their departments. Higher management should share responsibility and decision making with supervisors, who should do the same with their staffs. Employees should be encouraged to solve their own problems, too, instead of depending upon their supervisors to handle difficulties.

The laboratory benefits when all staff members are kept informed about productivity and lab financial performance, new health care legislation, and predicted changes in delivery of lab services. Awareness of these factors helps employees understand the organization's goals and why certain decisions are necessary. Employee needs must also be considered when decisions are made.

For these reasons, regularly scheduled employee meetings are important. But such meetings should serve as a two-way communication vehicle, not simply as a means for managers to convey information. At meetings or in one-to-one discussions with supervisors, employees' suggestions should be welcomed and recognized as valuable even when not used. Another outlet employees need is a realistic, functioning grievance procedure.

Learn to read warning signs. Unusual amounts of tardiness and absenteeism are sure indicators of a motivation problem, as are high rates of accidents, breakage, and spillage.

Commendations and discipline reports alike should be a part of personnel files. We don't take enough time to write a short note saying how well someone has done. I have used a form titled "Record of Commendation or Counseling" to note a superior job or something an employee should correct.

Challenging as well as routine tasks ought to be delegated to supervisors and employees. Delegation, of course, must be accompanied by authority to do the tasks.

Management should encourage employees to expand their knowledge and abilities and seek new work areas. They should be able to attend laboratory conferences outside their specialty and be reimbursed for them.

Employees have to comprehend their role as one part of a total health care team revolving around the patient. This is a very important current issue. Good managers encourage employees to interact with other departments and to participate in institutional committees and activities.

Finally, continual conflicts between supervisors and employees or between co-workers are sure to lower productivity. Management must counsel the combatants and set a time limit for improvement.

Taken together, all of the points in this article should provide a comprehensive approach to identifying areas that can block higher productivity. Some of these points can be improved easily, but others will require a change in management's attitude and behavior. No matter what, problems must be addressed.

Without the support and commitment of the entire staff, productivity will not increase. If anything, it will decrease further.

Learn to read warning signs. Unusual amounts of tardiness and absenteeism are sure signs of a motivation problem.
COPYRIGHT 1988 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Date:Apr 1, 1988
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